Intermenstrual bleeding

This condition is treated in the Gynaecology clinic.

Emergency Referral Criteria

Criteria for Emergency include: 

• Ectopic pregnancy 
• Ruptured haemorrhagic ovarian cyst 
• Ovarian torsion 
• Acute/severe pelvic pain 
• Significant or uncontrolled vaginal bleeding 
• Severe infection 
• Abscess intra pelvis or PID 
• Bartholin's abscess/acute painful enlargement of a Bartholin's gland/cyst 
• Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries 
• Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain 
• Urinary retention 
• Acute urinary obstruction 
• Any molar pregnancy 
• Inevitable and/or incomplete miscarriage 
• Hyperemesis gravidarum 
• Ascites, secondary to known underlying gynaecological oncology 

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Statewide Referral Criteria (SRC)

Criteria for referral to public hospital specialist clinic services

? Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

• Oncogenic Human Papilloma Virus (HPV), LBC (Liquid Based Cytology) prediction of any of the following: 
  • possible high-grade Squamous Intraepithelial Lesion (PHSIL) 
  • High-grade Squamous Intraepithelial Lesion (HSIL) 
  • possible high-grade glandular lesion  
  • Adenocarcinoma InSitu 
  • invasive cancer – cervical or endometrial 
• Focal endometrial lesion  

Semi-urgent (Category 2)

• Intermenstrual bleeding (IMB) not due to hormonal contraception 
• Abnormal cervical screening (other than for Cat 1) 
• Endometrium greater than 12mm/irregular on pelvic USS (TVS ideally day 5-10) 
• Persistent and/or unexplained Intermenstrual bleeding (IMB) 

Routine (Category 3)

• Intermenstrual bleeding (IMB) related to hormonal contraception that is not responding to medical management e.g. contraception manipulation 

Information to be included in the referral

(Referral may be returned without this)

Essential supporting information

Pathology

• Cervical screening test results
• BHCG
• Sexually transmitted infection screen

Imaging

• Pelvic Ultrasound  
• Transvaginal pelvic USS should be done when indicated.  

Note: If delay obtaining a USS may impact critical care this should be clearly indicated in the referral, however the scan should still be booked. Phone discussion on a case-by-case basis may be needed. 

Investigations/other

• Any relevant

Additional information

• History of abnormal bleeding
• Hormonal contraceptive use, efficacy and management

Interim/GP management

To refer a patient with this condition, please see the Gynaecology clinic page for the full referral process and templates.

For more information, please view the HealthPathways Tasmania website.

Additional resources

View all clinic availability